Non-small cell lung cancer: FDG PET for nodal staging in patients with stage I disease

PURPOSE: To determine the accuracy of 2-[fluorine-18]fluoro-2-deoxy-D-gluco se (FDG) positron emission tomography (PET) in the evaluation of regional l ymph nodes in patients with stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Imaging and clinical findings obtained during 5 year s in 84 patients (mean age, 66 years) were reviewed. Patients had thoracic computed tomographic findings of stage I NSCLC, an FDG PET study, and histo pathologic proof of lung cancer. At the time of diagnosis, disease stage wa s assigned on the basis of FDG PET results and was compared with the histop athologic stage to determine the accuracy of PET. RESULTS: When PET stage was compared with histopathologic stage, the diseas e in 72 (86%) patients was accurately staged with PET, understaged in two ( 2%), and overstaged in 10 (12%). The overall sensitivity, specificity, and positive and negative predictive values for PET of regional lymph nodal met astases were 82%, 86%, 47%, and 97%, respectively. CNCLUSION: FDG PET enables accurate staging of regional lymph node disease in patients with stage I NSCLC. A negative PET scan in these patients sugge sts that mediastinoscopy is unnecessary and that these patients can proceed directly to thoracotomy.